By: Alanna Shaikh
Visceral leishmaniasis, also known as kala-azar, affects about 500,000 people every year and 50,000-60,000 people die annually. It’s spread through the bite of the sandfly[ii]. Symptoms include fever, weight loss, and swelling of the spleen and liver. And, of course, eventual death in many cases;[iii] the disease is fatal if untreated.
I’ll repeat that for you. Fatal if left untreated.
The old treatment for leishmaniasis was a course of injections that lasted 30 days, and had an ugly risk of resistance. In parts of India, for example, the treatment had a 60% resistance rate. Stopping treatment early, of course, leaves the patient un-cured and at risk for resistance to leishmaniasis drugs. The length and cost of treatment were two major barriers to treatment. The new LEAP formulation Sodium Stibogluconate andParomomycin only takes 17 days, and it’s a combination treatment which is less prone to resistance than a single drug.[iv]
So it’s good news for a bad disease.
…Now I am going to rain all over your parade.
I’m pretty sure that the major barrier to access in leishmaniasis treatment wasn’t the length of the treatment or the base cost of the drugs. It was the under-the-table payment that you have to make to your doctor to access treatment. It won’t matter at all if the new drug is cheaper for the governments of the developing world if the doctors of the developing world still charge the same bribe to provide the treatment.
One study in Bangladesh found that 79% of patients reported that they paid “informal payments[v] “ in order to get their care, even though officially, leishmaniasis drugs and treatments are free. The median amount paid was $87, which was 1.2 times the annual per capita income of the population studied.
If we’re going to get the most impact possible out of the new treatment for leishmaniasis, it’s going to require some health system support to go with it. This would including developing new systems or improving old ones for making sure that cheap drugs are actually provided cheaply. Better incentives to health care providers might work, providing ways for patients to report providers who are charging bribes for care that’s supposed to be low-cost or free, or implementing a logistics and tracking system for drugs that doesn’t allow them to be sold outside the government system.
The new drug therapy is big news, but it’s not going to change anything on its own. It needs a health structure that actually works to go with it.
[i] A nice change from the more usual process which leads to a fabulous new treatment that no one can afford.
[iii] Yes, I know death is not technically a symptom.
[iv] The epidemiology of drug resistance is genuinely fascinating.
[v] Yes, that means bribes
Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.’ The views and opinions expressed by guest bloggers are not necessarily the views and opinions of the Global Network. All opinions expressed here are Alanna’s own and not those of any employer or the US government.